ICPD to MDGs: Missing links and common grounds

The ICPD agenda of reproductive health was declared as the most comprehensive one, which had actually broadened the spectrum of reproductive health and drove the states to embark upon initiatives to improve reproductive health status of their populations. However, like all other countries, Pakistan also seems to have shifted focus of its policies and programs towards achieving MDGs. As a result, concepts highlighted in the ICPD got dropped eventually. In spite of specific goals on maternal and child mortalities in MDGs and all the investment and policy shift, Pakistan has still one of the highest maternal mortality ratios among developing countries. Lack of synchronized efforts, sector wide approaches, inter-sectoral collaboration, and moreover, the unmet need for family planning, unsafe abortions, low literacy rate and dearth of women empowerment are the main reasons. Being a signatory of both of the international agendas (ICPD and MDGs), Pakistan needed to articulate its policies to keep the balance between the two agendas. There are, however, certainly some common grounds which have been experimented by various countries and we can learn lessons from those best practices. An inter-sectoral cooperation and sector wide approaches would be required to achieve such ambitious goals set out in ICPD-Program of Action while working towards MDGs. There is a need of increasing resource allocation, strengthening primary health care services and emergency obstetric care and motivating the human resource employed in health sector by good governance. These endeavors should lead to formulate evidence based national policies, reproductive health services which are affordable, accessible and culturally acceptable and finally a responsive health system

Understanding the Drivers of Sustainable Entrepreneurial Practices in Pakistan’s Leather Industry: A Multi-Level Approach

Purpose: The main objective is to analyse the drivers of sustainable entrepreneurial practices in SMEs operating in a developing economy. The secondary objectives are to explore the relationship between these drivers and to draw out the implications for policy and practice. Design/methodology/approach: The research is informed by the literature on sustainable entrepreneurship, and on the drivers of pro-environmental practices in SMEs. It reports on the results of an intensive multi-level empirical study, which investigates the environmental practices of SMEs in Pakistan’s leatherworking industry using a multiple case study design and grounded analysis, which draws on relevant institutional theory. Findings: The study identifies that coercive, normative and mimetic isomorphic pressures simultaneously drive sustainable entrepreneurial activity in the majority of sample SMEs. These pressures are exerted by specific micro, meso and macro level factors, ranging from international customers’ requirements to individual-level values of owners and managers. It also reveals the catalytic effect of the educational and awareness-raising activities of intermediary organisations, in tandem with the attraction of competitiveness gains, (international) environmental regulations, industrial dynamism and reputational factors. Practical implications: The evidence suggests that, in countries where formal institutional mechanisms have less of an impact, intermediary organisations can perform a proto-institutional role that helps to overcome pre-existing barriers to environmental improvement by sparking sustainable entrepreneurial activity in SME populations. Originality/value: The findings imply that the drivers of sustainable entrepreneurial activity do not operate in a ‘piecemeal’ fashion, but that particular factors mediate the emergence and development of other sustainability drivers. This paper provides new insights into sustainable entrepreneurship and motivations for environmental practices in an under-researched developing economy context

Unveiling the consensus: Putting people first in Pakistan\u27s development agenda

This document contains the consensus from the Population Summit held in Islamabad, Pakistan, November 5–6, 2015. To date, an enduring commitment to a sound and adequate population welfare program has eluded Pakistan, leaving millions of couples who want to wait before having their next child or who consider that they have enough children, without good access to family planning. However, in the wake of devolution, in part through efforts of donors and civil society for awareness building, advocacy, and dialogue, opinion among all major stakeholders is coalescing around the need to address Pakistan’s alarming maternal and child health indicators through strong programming, including access to voluntary birth spacing services. The majority of elected representatives from all provinces and major political parties, and religious scholars of all major schools of thought, came out to express their unequivocal and enthusiastic support for the right of couples to use contraception for healthy spacing and timing of pregnancies

Women in Local Government: The Pakistan Experience

This article looks at women's representation in local government in Pakistan, focusing particularly on the introduction of a quota setting 33 per cent of the seats for women brought in under General Musharraf's Devolution of Power Plan in 2000. The article suggests that establishing a direct correlation between a woman's quota and regime type is problematic. It demonstrates a complex pattern of interaction on the issue by both the military and civilian regimes in Pakistan. Policies which have been brought in, informed both by political pragmatism and ideological continuity, have been wide ranging and almost contradictory in nature. The article also highlights the importance of the roles of NGOs and women activists in providing capacity building and support for mobilising women both as candidates and as voters. It shows that women's struggles at grassroots can bring achievements even in spaces where patriarchal norms rule, but these pathways to political empowerment are uneven and unpredictable

Gendered immobility: influence of social roles and local context on mobility decisions in Pakistan

This paper examines the instances of one-day immobility in Pakistan and reports its socio-demographic determinants using the nationally representative dataset of the 2007 Pakistan Time Use Survey. Of 37,830 time diary respondents, nearly 30% did not report travel during the diary day. Homemakers and those out of the workforce were more likely to be immobile than employed or student respondents. Immobility rates were very high among women (55%) as compared to men (4%). Among women, those between 20 and 34 years of age, married, with children, having better education, dependent on other household members and those living in higher income households were more likely to be immobile. The excessive gender nature of immobility seems to be triggered by a gender-based sociocultural environment, which restricts female mobility due to family honor concerns. Other than this, those living in the provinces of Sindh and Khyber Pakhtunkhwa or in urban areas were more likely to be immobile than those living in Punjab and Sindh provinces or in rural areas. The significant geographic effect at broader spatial scale is caused by the demographic structure as well as due to differences in the social and cultural context of these areas. Finally, questions regarding the measurement of immobility and the potential implications of increased female immobility are discussed

How to understand Pakistan’s hybrid regime: the importance of a multidimensional continuum

Pakistan has had a chequered democratic history but elections in 2013 marked a second turnover in power, and the first transition in Pakistan’s history from one freely elected government to another. How do we best categorize (and therefore understand) political developments in Pakistan? Is it now safe to categorize it as an electoral democracy or is it still a hybrid case of democracy? Using the Pakistani case as an example, this article argues that hybrid regimes deserve consideration as a separate case (rather than as a diminished sub type of democracy or authoritarianism), but must be categorised along a multidimensional continuum to understand the dynamics of power within the political system

Understanding gendered influences on women's reproductive health in Pakistan: Moving beyond the autonomy paradigm

Recent research and policy discourse commonly view the limited autonomy of women in developing countries as a key barrier to improvements in their reproductive health. Rarely, however, is the notion of women's autonomy interrogated for its conceptual adequacy or usefulness for understanding the determinants of women's reproductive health, effective policy formulation or program design. Using ethnographic data from 2001, including social mapping exercises, observation of daily life, interviews, case studies and focus group discussions, this paper draws attention to the incongruities between the concept of women's autonomy and the gendered social, cultural, economic and political realities of women's lives in rural Punjab, Pakistan. These inadequacies include: the concept's undue emphasis on women's independent, autonomous action; a lack of attention to men and masculinities; a disregard for the multi-sited constitution of gender relations and gender inequality; an erroneous assumption that uptake of reproductive health services is an indicator of autonomy; and a failure to explore the interplay of other axes of disadvantage such as caste, class or socio-economic position. This paper calls for alternative, more nuanced, theoretical approaches for conceptualizing gender inequalities in order to enhance our understanding of women's reproductive wellbeing in Pakistan. The extent to which our arguments may be relevant to the wider South Asian context, and women's lives in other parts of the world, is also discussed

Maternal deaths in Pakistan : intersection of gender, class and social exclusion.

Background: A key aim of countries with high maternal mortality rates is to increase availability of competent maternal health care during pregnancy and childbirth. Yet, despite significant investment, countries with the highest burdens have not reduced their rates to the expected levels. We argue, taking Pakistan as a case study, that improving physical availability of services is necessary but not sufficient for reducing maternal mortality because gender inequities interact with caste and poverty to socially exclude certain groups of women from health services that are otherwise physically available. Methods: Using a critical ethnographic approach, two case studies of women who died during childbirth were pieced together from information gathered during the first six months of fieldwork in a village in Northern Punjab, Pakistan. Findings: Shida did not receive the necessary medical care because her heavily indebted family could not afford it. Zainab, a victim of domestic violence, did not receive any medical care because her martial family could not afford it, nor did they think she deserved it. Both women belonged to lower caste households, which are materially poor households and socially constructed as inferior. Conclusions: The stories of Shida and Zainab illustrate how a rigidly structured caste hierarchy, the gendered devaluing of females, and the reinforced lack of control that many impoverished women experience conspire to keep women from lifesaving health services that are physically available and should be at their disposal

Are children with tuberculosis in Pakistan managed according to National programme policy guidelines? A study from 3 districts in Punjab

<p>Abstract</p> <p>Background</p> <p>The adherence to policies of National TB Control Programme (NTP) to manage a case of tuberculosis (TB) is a fundamental step to have a successful programme in any country. Childhood TB services faces an unmet challenge of case management due to difficulty with diagnosis and relatively new policies. For control of childhood TB in Pakistan, NTP developed and piloted its guidelines in 2006-2007. The objective of this study was to compare the documented case management practices of pediatricians and its impact on the outcome before and after introducing NTP policy guidelines.</p> <p>Findings</p> <p>An audit of case management practices of a historical cohort study was done in children below 15 years who were put on anti-tuberculosis treatment at all nine public hospitals in three districts in province of Punjab. The study period was two years pre-intervention (2004-05) and two years post-intervention (2006-07) after implementation of new NTP policy guidelines for childhood TB. There were 920 childhood TB cases registered during four years, 189 in pre-intervention period and 731 in post-intervention period. The practices changed significantly in post-intervention period for use of tuberculin skin test (63% of pulmonary cases, 19% of extrapulmonary cases and 67% for site unknown), and for the use of chest x-ray (69% of pulmonary cases, 16% of extrapulmonary cases and 74% for site unknown). Diagnostic scores were recorded for only a minority of cases (18%). The proportion of correct drugs pre- and post-intervention remained same. There were unknown treatment outcomes in 38 out of 141 cases (27%) in pre-intervention and in 483 out of 551 cases (87%) post-intervention, all among the 692 cases without documented treatment supporter.</p> <p>Conclusions</p> <p>The study has shown that pediatricians have started following parts of the national policy guidelines for management of childhood TB. The documented use of diagnostic tools is increased but record keeping of case management practices remained inadequate. This seems to increase case finding substantially but the treatment outcomes were poor mainly due to unknown outcomes. Development and implementation of standardized operational tools and regular monitoring system may improve the services.</p